Facilitator Application – Motherless Daughters Ministry

Name*

First Middle Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone Number to reach you*

Emergency Contact Name*

Emergency Contact Phone Number*

Email*

Education Level*

Diploma

Some College

Bachelors

Masters

Certifications or licensures held:

CEUs required?

Marital Status:*

Married

Single

Currently Employed?*

Yes

Employer:

May we contact your church and organization about the Motherless Daughters Ministry?*

Yes

Name of Organization

Organization Phone

Completion of a Motherless Daughters course is a prerequisite to become a facilitator. Year attended?*

Who facilitated your course?*

Why do you want to become a Facilitator?*

Initial*

This training requires a large time commitment. Please understand you must complete all courses to be considered for certification. If a conflict arises it is your responsibility to work with the leader to cover missed materials. Please initial that you understand what is stated.

Once you complete this training and practicum, you are committing to volunteer in the Motherless Daughters Ministry 100 hrs. over the next 2 years. If you do not begin volunteering in the Motherless Daughters Ministry within 3 months of completing your training, a bill for $800.00 will be sent to you.

In obedience to God’s calling, we trust you will act with integrity and will meet your responsibility in either time given or fee paid to the Motherless Daughters Ministry.

Complete this application. If you do not meet the requirements for this course your money will be refunded to you prior to the start of the course..

Each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed and/or initialed, and that any electronic signatures and/or initials appearing on this Agreement or such other documents are the same as handwritten signatures and/or initials for the purposes of validity, enforceability, and admissibility.

Signature of Applicant*

Date*

This field is for validation purposes and should be left unchanged.